Writing Multiple Choice Test Items - Part Four: The Analysis Question

Learning at the analysis level requires a higher intellectual level than comprehension and application because it requires an understanding of both the content and the structural form of the material.

Analysis involves the ability to:

Discriminate complex information (multiple factors) by separating out and prioritizing the information into smaller elements, to clearly understand their relationship.

1. Categorize patterns, ideas, or recurring themes.
2. Identify the relationship of component parts as a whole.
3. Analyze organizational structures.
4. Detect cause-and-effect relationships.
5. Evaluate relevancy of data.
6. Recognize logical fallacies in reasoning
7. Make inferences, and/or find evidence to support generalizations.

Examples:

1. Determining which client should be seen first.
2. Evaluating multiple client information.

Examples of analysis-level qualifiers: analyze, appraise, arrange, categorize, classify, compare, connect, contrast, correlate, criticize, differentiate, discriminate, distinguish, divide, examine, experiment, explain, group, infer, inquire, interpret, investigate, order, prioritize, question, select, separate, subdivide, survey

Examples of analysis-level NCLEX-style questions:

The nurse has been assigned to a group of clients. Based on the information provided, which client should be seen first?

1. A 68-year-old client who had total hip replacement surgery 6 hours ago and is complaining of moderate discomfort at the surgical site.
2. A 32-year-old client with a urinary tract infection who is receiving an intravenous antibiotic and complaining of swelling in the tongue.*
3. An 82-year-old client with emphysema who is receiving 2 liters of oxygen and is concerned about a pulse oximetry reading of 91%.
4. A 48-year-old client with a hemoglobin of 9.5 g/dl who is receiving ferrous sulfate supplements, and is complaining of feeling tired.

In this example, the student must interpret multiple information on four separate clients in an effort to determine which client has the most important need or most life-threatening situation. The client receiving the intravenous antibiotic may be experiencing a possible airway obstruction secondary to an allergic reaction.

The nurse is caring for a 72-year-old client on a cardiac step-down unit. The client's electrocardiogram (ECG) rhythm strip is illustrated below. The client's blood pressure is 84/40. He states, "I feel light-headed." which of the following drugs/ agents should the nurse be prepared to administer? (insert an ECG strip of sinus bradycardia with hr 42 beats per minute.)

1. Atropine*
2. Digoxin
3. Amiodarone
4. Metoprolol

In this example, the student must recognize sinus bradycardia from an ECG rhythm strip, the signs and symptoms of someone who is becoming hemodynamically unstable with sinus bradycardia, and anticipate the appropriate intervention (medication) that will be ordered.

Analysis questions frequently feature prioritization or delegation-type scenarios and are the most challenging of all the nclex-type multiple-choice items. These are the questions that may have four "correct" answers and the student must pick the best answer out of the selection.

References

NCSBN Learning Extension

http://www.accd.edu/sac/english/mgarcia/writfils/learnlev.htm

Critical and Creative Thinking - Bloom's Taxonomy

Counselling Services - University of Victoria

Major Categories in the Taxonomy of Educational Objectives (Bloom)